How to Best Treat Foot Arthritis with Seattle Podiatrist Larry Huppin
Hi. So today we're going to talk about arthritison top of the foot or what's called midfoot arthritis. That's arthritis in these jointsthrough here. This is the second most common cause that we see causing pain on the topof the foot. The first one is a condition called dorsal compression syndrome, whichjust means that the foot is collapsing down and all these bones get pressed together toomuch but there's no actual damage to the joint. For information on that problem, go to ourwebsite and do a search for quot;dorsal compression syndromequot; or quot;top of foot pain.quot; However, today we're going to talk about arthritisin these joints. So longterm, this foot flattening
out too much can start to damage these joints.As the foot goes down, all these bones get pressed together. Initially it just causespain, but over time, it starts to wear away the cartilage on the inside of these joints,and that can cause a lot of pain. So after that occurs, almost any motion in this areawill start to cause pain. Also, a lot of times people will see a bump, a bone occurring ontop of the foot associated with that arthritis. When we look at treating it, our first goalis to avoid surgery and still eliminate a 100% of the pain. You really should look atsurgery as only the very, very last resort. And in most cases, in fact, in almost allcases, we can treat this without doing surgery.
Our goal here is to limit motion in thesejoints, so what we're going to do is put something under the arch of the foot. We're going totake an orthotic device, put it underneath there, and we're going to try and use thatto stop the motion in that joint. For that to work the best, we want that orthotic toconform extremely close to the arch of the foot. It's called a total contact orthotic.Again, you can look up quot;total contact orthoticquot; on our website. That type of orthotic doesthe best job of limiting motion in this area. If that's not enough, we can actually do someshoe modifications where we put what's called the rocker on the bottom of your shoe to limitthe motion in that foot. This is a big orthotic
that we might use in a men's dress shoe orin anybody's athletic shoe. For women's dress shoes, we can use much, much smaller devices,as we aren't going to a flat or a heel, but the key is that still conforms very closeto the arch of the foot. So if you think you might have arthritis inyour midfoot, what you want to do first is find a podiatrist in your area who specializesin orthotics and biomechanics. If you're in our area, go to our website and you can findcontact information there. If you're not in our area, look for someone who has that specialty. If you want to try and treat this yourself,go to our website and do a search for quot;selftreatment
for midfoot arthritisquot; or quot;selftreatmentfor foot arthritisquot; and you'll find all kinds of hints there, we'll recommend some overthecounterarch supports you can try instead of the custom ones. We'll recommend some types of shoesyou can use and a number of different things you can do initially to try and treat thisproblem.
Second Toe Pain and Plantar Plate Tears Seattle Podiatrist
Today I want to talk about pain in and underthe second toe. Now the second toe lives a very, very rough life. It has more force puton it than any of the other toes. So it's much more likely to get injured and much morelikely to be painful. This is due simply to the way that most feet function. So if youlook at a normal human step, most of us hit on the outside of our heel, we go forward,big toe joint bends, and we come off the ground. Now some people roll in too much or overpronate,and when that occurs, the ground presses up under this big, first metatarsal bone. Nowif you look at the bottom of the foot, this first metatarsal is the biggest of any ofthe metatarsals, and it should take up about
half the weight of the ball of the foot. Butin someone who pronates or rolls in too much, the ground pushes up under this area, andthis actually, this bone actually has its own independent range of motion. So it's pushedup out of the way, and it no longer bears as much weight as it should. That leaves this little second metatarsalbone taking up a lot of extra force. And so you end up getting excessive pressure underthere that leads to a lot of different problems. Number one is just inflammation in this area.So a lot of people who roll in too much or maybe have bunions, they're not bearing enoughweight on that first metatarsal, and if you
press up under this area it will be painful.What that is is an inflammation of the joint, or actually the ligaments that make up thejoint. They are called the capsule of the joint,and you can see what that looks like over here. This is a different joint, but that'swhat that capsule looks like. It's a tight array of ligaments that make up that joint.And that capsule can be irritated, and that is a condition called capsulitis. Now if youhave capsulitis, our primary goal is to transfer pressure off of this area. So we might usean over the counter arch support. And if you go on our website and do a search for capsulitisor a condition called metatarsalgia, which
just means pain under the ball of the foot,you can find a list of good over the counter supports that you can put into your shoesthat'll get pressure off of this area quite effectively. Now if that's not enough, we can make youa custom orthotics. Custom orthotics work better for this condition because they grabthe arch tighter through here, and they transfer pressure more effectively off the ball ofthe foot. Now make sure you go to someone that really knows what they're doing. I seea lot of orthotics made that are just not high enough to get pressure off of that secondmetatarsal joint. And it's just a real problem
in the industry that these orthotics are notalways made the way they should be. Couple of other conditions that can causepain in this area. If you have pain in this region that has not responded to standardtreatment, that's sometimes because there's been a tear of the capsule of the joint. There'sa portion on the very bottom of this toe, on the joint that's called the plantar plate.And that essentially a thickened portion of the capsule. Now that can actually get a tearin it, particularly if there's either longterm pressure on the area or an injury that bringsyour toe up like that, it can tear that region. And that often, what we'll see in that situationis people that just don't get better. They
don't respond to standard treatment such asorthotics, or shoes like this that have a rocker sole on them that will rock throughthe step and take pressure off that area. Sometimes we need to immobilize this for awhile. If you're just not getting better, we mayneed to do some more involved imaging. Obviously we would have already have gotten Xrays onthe area. But if you're just not getting better, we may do a test called an arthrogram MRIwhere a little bit of a dye is put into this joint, and then an MRI is done. And you lookand see does the dye leak out. That dye should not leak out. And if it does, then it's anindication there's a tear on that joint. So